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Comment: Win for doctors, insurance, and drug companies (Score 2) 392

But mostly a lose for patients.

The reason it's a win for doctors is that in our "fee for service" system they don't make much on a simple office visit, especially if they have to take the time to write a prescription. There's also ongoing overhead for prescriptions - whenever you run out of refills the pharmacy has to reauth, which takes up staff time. (This last is why the office where my son works has additional staff on hand on fridays, which is the day that everyone does their refills.) It may also reduce liability, although exactly how that will play out is harder to predict.

It's an obvious win for insurance because most OTC stuff isn't covered. And likewise for drug companies, who will sell more product, a lot of it to people who don't really need it.

The big losers will be patients. Sure, some people will have easier access to the meds they need. But costs will overall be higher, and some of the meds they are talking about aren't all that safe. Statins, for example, may be great at treating high cholesterol, but over time they can cause liver damage. Most of the antihypertensives are reasonably safe when taken at the correct dose, but take a bit too much and things like positional vertigo can occur. And as others have pointed out, the inability to track OTC meds can result in serious drug interactions or overdoses. Indeed, this is already a serious problem with acetaminenophen - so many different products contain it that it's easy to get an overdose, and boom goes your liver.

Comment: Andreas Vesalius (Score 5, Informative) 108

Irrespective of their quality, Da Vinci's drawings did little at the time to challenge the use of Galen's work (which was based on dissection of animals and therefore quite inaccurate). That particular bit of heavy lifting was done by Andreas Vesalius, who not only debunked Galen, but was also the first to publish a comprehensive work on anatomy (De Humani Corporis Fabrica). His work has repeatedly been found to be highly accurate, especially considering the conditions under which it was produced. An amusing side note is that it was so well regarded it was extensively pirated.

Vesalius made a lot of enemies by going against what amounted to the medical establishment of the time. After repeated challenges his critics actually resorted to the howler that the human body must have changed (evolved? ;) since Galen studied it.

Vesalius has always been a personal hero of mine - a guy who developed an interest in an an important area (anatomy), and pursued it, at great personal cost, with as much thoroughness and rigor as could be had at the time.

Comment: Installed a full height rack 10 years ago (Score 2) 402

by EdwinFreed (#39854239) Attached to: Ask Slashdot: Building A Server Rack Into a New Home?
This was when we were remodeling. The cost was negligible compared to everything else. It's been about 2/3 full ever since, and I have never regretted it.

The thing I do regret is not running enough cable. I put two CAT-5E in each room and it isn't enough. I should have pulled 4 everywhere. I've had to add a couple of runs, and doing that after the walls are closed up is difficult and expensive.

I've found Wifi to be a poor substitute for wired. When two laptops are backing up trying to watch some video is painful.

Comment: Correction (Score 1) 130

by EdwinFreed (#39852669) Attached to: Doctors Transplant Same Kidney Twice In Two Weeks
Think about it: Cadaveric transplants often come from people who were in an accident. The time available to match the organ in such cases is not going to significantly different than if you grabbed someone off the street intending to steal their organs.

When there's plenty of time, as in the case of altruistic donations, yes, full match testing is performed. But when there's not, it isn't, and it usually works.

In any case, these days not only are transplants done with little or no MHC match (mine was only 2 out of 6), but they are even done against blood type. The process for that is fairly involved, making it impractical to do if you're going to transplant a stolen organ. That said, the odds are over 40% that a person grabbed at random in the US is going to be type O, and type O organs are blood type compatible with everyone.

Comment: Medicare age exceptions (Score 2) 130

by EdwinFreed (#39842233) Attached to: Doctors Transplant Same Kidney Twice In Two Weeks
Actually, end stage renal disease (ESRD) including both dialysis and transplants, is covered by Medicare regardless of age. The only other condition that enjoys this status is amyotrophic lateral schlerosis (ALS). I have no idea why ALS is handled this way, especially since there are several similar motor neurone diseases that aren't covered, but in the case of ESRD, it's because when dialysis was first developed it was extremely expensive and insurance refused to cover it. The result was few dialysis machines were built and the costs remained very high. ESRD was and is very common, so laws were passed to extend medicare to cover it. (And the costs did drop, but it's still expensive.) And when transplants became available, the coverage was extended again to cover that.

There is, however, a little gotcha in all this. The drugs needed to prevent rejection of a transplant are also expensive. And once you have a transplant, you don't have ESRD any more, so your Medicare coverage ends. This was addressed by extending the coverage for 18 months, which I guess is how long transplants used to last. But these days the average is more like 9 years. So what happens is someone gets a transplant that's paid for by Medicare, their meds are paid for for 18 months, then the coverage stops, they can't afford the meds and the transplant stops working. So they go back into ESRD and need dialysis, at which point they're covered again.

This is absolutely insane no matter how you look at it, since the meds are typically around $10K/year whereas dialysis is closer to $50K/year. So not only do you waste a precious organ, it ends up costing more.

The good news is that one of the provision of the AHA that goes into effect in 2014 is to extend medicare to cover the meds indefinitely.

Comment: Re:Why wasn't it returned? (Score 3, Interesting) 130

by EdwinFreed (#39842143) Attached to: Doctors Transplant Same Kidney Twice In Two Weeks
Substantial risk understates the situation if anything. The fact is removing a kidney is a pretty big deal whereas putting one into someone is a lot simpler. This is because they put transplanted kidneys into the lower abdomen inside the muscle layer but outside the peritoneal wall. (The old failed or failing kidneys are only removed if absolutely necessary.) Removing a kidney, OTOH, means going through the abdomen to the other side. Even though it's done laparoscopically, it's still fairly traumatic, to the point where altruistic donors (that's what they are called) have a significantly worse time of it than the recipient in the first couple of weeks post-transplant. Because of this, there is no way in hell any remotely competent surgeon would agree to put back a kidney they are sure she doesn't need so soon after the original procedure. (Donors undergo extensive testing before such procedures. And it's actually surgeons plural, since reattaching blood vessels and hooking up ureters are actually different specialties.)

For that matter, they would not have removed the transplanted kidney from the original recipient were it not for the small matter that according to the article, it was killing him. (When a transplanted kidney fails and another transplant is done they don't remove it unless absolutely necessary, with the result that someone can end up with four or more kidneys.) So they were going to end up with a kidney and no place to put it. Rather than toss it in the garbage, my guess is they started calling people at the top of the list who were type compatible until they found one willing to give it a go.

I'll also point out that one of the side benefits of being a donor is that in the unlikely event that your remaining kidney fails, you automatically go to the top of the transplant list. And in most cases 100% of the donor's costs are paid for.

Comment: That's not how it works (Score 1) 130

by EdwinFreed (#39842051) Attached to: Doctors Transplant Same Kidney Twice In Two Weeks
That may be true for other organs, but not kidneys. And this is for good reason: With, say, a heart or lung or liver, you either get one or you die in fairly short order. But we have an acceptable substitute for a kidney: Dialysis. So, issues of compatibility and availability aside, kidneys are allocated on a first-come-first-served basis,

What this translates to in practice is that if you're blood type O, expect a *long* wait. This is mostly because type Os can only get a type O kidney, meaning about 60% of the kidneys that show up aren't going to be compatible. (This actually isn't true - there's a therapy that allows transplants against type - but since it requires extensive preparation in advance it isn't really practical for cadaveric transplants.) It, OTOH, you're type AB, your wait time is likely to be much less, mostly because any kidney that shows up will work for you.

Comment: Re:nonsense (Score 1) 355

by EdwinFreed (#39748281) Attached to: FBI Seizes Server Providing Anonymous Remailer Service
This approach only works if the messages continue to be sent using the same mix. Which given all the publicity this has gotten and how these sorts of crazies tend to monitor every reference they get in the media, seems very unlikely.

More specifically, they've seized one server, presumably after monitoring it for some time and capturing all the incoming messages. Now they use the private key to re-encrypt the message and look for a match among the incoming traffic. Assuming that traffic wasn't sent using a TLS mechanism with perfect forward secrecy, they now have the IP address of the next to last server in the mix. But what they don't have is any recordings of the traffic getting to that server. And unless the person sending these messages sends some more using the same mix, they will never be able to catch any.

I supppose it's possible that after monitoring the traffic, they also started monitoring traffic coming in to every host that ever sent this system mail. But I'm dubious of the practicality of that, both in the legal and technical sense.

What they should have done is use one of those handy-dandy national security letters or whatever they are called to gain access to the server in secret. They could have pried the private key loose that way, then initiated monitoring on the next server up the chain, another letter, and so on.

Of course this also falls apart if one of the servers is some place that doesn't like the US and won't honor requests from US law enforcement.

Comment: Re:Common Misconceptions (Score 4, Funny) 663

No, the correct answer is B. Mushroom vs. plant is a living thing vs. a group of living things this specific living thing isn't in. Rocks and tables aren't alive. Pizza, on the other hand, can be, if the old one I found in our refrigerator the other day is any indication.

Comment: Exactly (Score 1) 998

by EdwinFreed (#39625487) Attached to: Hybrid Car Owners Not Likely To Buy Another Hybrid
We currently have a 2010 Prius and a 2011 Leaf. The Prius replaced a 2001 Prius that went to our son. The 2001 is getting a little long in the tooth (mostly because it's managed to be rear-ended 5 times, one of which nearly totaled the car) so the plan is to replace the 2010 Prius with a Tesla and then the 2010 Prius becomes our son's car.

But like you, I suspect our shift to EV is not in any way representative. It's just one factor among many. As you say, a lot of the tech associated with hybrids actually isn't the hybrid part and it's showing up elsewhere. Add to that the fact that the hybrid brand has been weakened by things where the hybrid part didn't really buy you that much and in some cases almost nothing - and the people who bought those are bound not to waste the extra $$$ a second time.

By not looking at the reasons why people are planning to switch, what they're planning to switch to, or even when they're planning to make the switch, the study changes from being informative to little more than a curiosity. Hell, for all we know most of them are planning to hold on to their hybrids until electrics fall in price.

A great nation is any mob of people which produces at least one honest man a century.

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